Detailed exams might benefit older cancer patients

NEW YORK (Reuters Health) - Older people with cancer who
seem to be coping well with the disease might still earn poor
health scores when examined by a geriatrician, according to a
new analysis of past studies.

The review focused on older people with leukemia and
lymphoma. The findings suggest detailed examinations of those
patients provide a better, more nuanced picture of their health
for oncologists making treatment decisions, researchers said.

"Most of what we know about treating cancer comes from
research that was done in young, fit patients," Dr. Marije
Hamaker wrote in an email to Reuters Health.

Hamaker, a geriatrician at Diakonessenhuis, a hospital in
Utrecht, The Netherlands, led the new review.

"It is incorrect to assume that what is best for a younger
person will also be best for someone who is older," Hamaker
said.

She and her team reviewed 18 published studies that looked
at geriatric assessments among people with blood and bone marrow
cancers. Those patients were 73 years old, on average.

The researchers found that patients who scored well on a
simple health scale tied to daily activities were actually
struggling in other areas especially relevant to the elderly,
like cognitive function, depression, social environment,
nutrition, medication interactions and frailty.

Ten of the studies examined relationships between geriatric
assessment scores and death. They showed poor physical
performance measured at a clinic and worse nutrition were
consistently linked to a higher chance of dying early.

In the past, an older person's mental and physical decline,
as well as declining social networks, were "written off as part
of the aging process," said Dr. Heidi Klepin. "And yet all of
those things have a major impact on how a person handles a
disease."

Klepin, who was not part of the study, is an oncologist
trained in geriatric care at the Comprehensive Cancer Center at
Wake Forest Baptist Medical Center in Winston-Salem, North
Carolina.

"We don't have a lot of knowledge on older patients because
they are rarely included in clinical trials," she said. That's
because those trials often leave out people who have other
health complications.

But, "there's an ever-increasing number of older patients
being diagnosed with cancer," she said, and older patients
require more complex care than younger ones.

Nearly one third of new blood and bone marrow cancers occur
in adults over age 75, the researchers write in the journal
Leukemia Research.

They stressed that there is not enough information to make
cancer treatment decisions based on geriatric assessment scores.
It's also not clear if the assessments benefit patients going
forward.

"Do geriatric assessments result in a better quality of life
or a different outcome with cancer? No one has done a randomized
clinical trial to answer that question yet because it is very
complicated," Klepin said.

The researchers suggest that geriatric assessments can play
a role in cancer patient care and well being, but more research
on the subject is needed.

"Geriatric assessments are a way of taking into account
social, cognitive and physical function, as well as
pharmacological concerns. (They) assess multiple health issues
all at once," Klepin said.

"There is no question that as a doctor, I will be better
prepared to help my patient the more I know about them."